Central hepatectomy for centrally located malignant liver tumors: A systematic review

AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed in MEDLINE for articles published from January1983 to June 2013 to evaluate the evidence for andagainst CH in the management of central hepatic malig-nancies and to compare the perioperative variables andoutcomes of CH to lobar/extended hemihepatectomy. RESULTS: A total of 895 patients were included from21 relevant studies. Most of these patients who un-derwent CH were a sub-cohort of larger liver resectionstudies. Only 4 studies directly compared Central vshemi-/extended hepatectomies. The range of opera-tive time for CH was reported to be 115 to 627 min andPringle's maneuver was used for vascular control in themajority of studies. The mean intraoperative blood lossduring CH ranged from 380 to 2450 mL. The reportedmorbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mor-tality ranged from 0.0% to 7.1% with an overall mor-tality of 2.3% following CH. The 1-year overall survival(OS) for patients underwent CH for hepatocellular car-cinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserv-ing procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.

Chinese expert consensus on laparoscopic hepatic segmentectomy and subsegmentectomy navigated by augmented-and mixed-reality technology combined with indocyanine green fluorescence imaging

Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomical,functional,and radical hepatectomy through tumor identification and localization of target hepatic segments,driving a transformative shift in themanagement of hepatic surgical diseases,moving away from traditional,empirical diagnostic and treatment approaches toward digital,intelligent ones.The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association,Digital Medicine Branch of the Chinese Medical Association,Digital Intelligent Surgery Committee of the Chinese Society of ResearchHospitals,and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus.This consensus provides a comprehensive outline of the principles,advantages,processes,and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection.The purpose is to streamline and standardize the application of these technologies.

肝门蒂及其内容的应用解剖

目的 :为肝大部切除和活体近亲肝移植提供解剖学基础。方法 :在 3 0例成人尸体肝门附近切开肝实质 ,测量切口深度 ,即肝表面至深方Glisson囊的距离 ,门静脉及其左、右支末端直径和长度 ,观察肝动脉的分支及毗邻。结果 :①切口Ⅰ～Ⅴ深度分别为 13 .4± 0 .5、13 .5± 0 .5、12 .9± 0 .4、13 .9± 0 .4和16.8± 0 .4mm ;②门静脉末端直径 11.9± 0 .3mm ,左支横部及右支长度分别为 2 7.9± 0 .7和 19.0± 0 .7mm ;③罕见的门静脉右前支起于左支者占 3 .3 % ( 1例 ) ;④肝动脉CouinaudⅣ段支经脐静脉窝右缘和Ⅱ、Ⅲ段支经门静脉左支后下方或上方者 ,共占 5 1.7%。结论 :①肝下面各切口 15～ 2 0mm深可达Glisson囊 ,但切口位置和深度随手术类型及肝外形而异 ;②肝流入血管的分支和走行在Glisson囊内无特定规律 ,手术前肝动脉、门静脉造影 ,术中仔细解剖十分重要。

增强与混合现实技术联合吲哚菁绿分子荧光影像导航腹腔镜肝段、亚肝段切除术中国专家共识(2023)

增强与混合现实技术可实现腹腔镜手术实时融合交互投影,吲哚菁绿分子影像技术通过对肿瘤识别和定位目标肝段,实现了解剖性、功能性、根治性肝切除术,使肝脏外科疾病由传统经验性诊治模式向数字智能化诊治模式转变。中华医学会外科学分会肝脏外科学组、中华医学会数字医学分会、中国研究型医院学会数字智能化外科专业委员会和中国医师协会肝癌专业委员会组织国内相关领域专家制定本共识,对增强与混合现实技术联合吲哚菁绿分子影像导航腹腔镜肝段、亚肝段切除术的优势、流程及要点进行介绍,以使该技术的应用实现流程化和标准化,便于推广。

累及多肝门的巨大肝肿瘤切除术(附22例报告)

目的探讨累及多肝门的巨大肝肿瘤切除的安全性、可行性及手术方法.方法总结1996年4月至2003年4月间我科收治的累及多肝门的巨大肝肿瘤22例,肿瘤平均直径12.9 cm(8～23 cm).肿瘤同时累及第1和第3肝门者9例,同时侵及第2、3肝门者8例,累及1、2、3肝门者5例.肝肿瘤包括:原发性肝细胞癌14例,胆管细胞癌1例,肝血管瘤4例,肝母细胞瘤3例.癌灶有完整包膜12例(55.5%),无完整包膜10例(45.5%).对肝肿瘤所施手术方法、并发症防治等进行分析.结果全部病例均手术切除,无手术死亡,术中平均出血量1 480 ml(450～4 200 ml),12例施行第1肝门阻断,10例采用了肝门区域选择性血管阻断,手术时间平均195 min.术后无严重并发症,均治愈出院.本组22例病人经1～8年随访,术后存活时间最长已达8年,1年生存率为90.9%(20/22).结论对于累及多肝门的巨大肝肿瘤,只要正确把握手术指征,熟练掌握切肝技术,手术切除是安全的、可行的最佳治疗手段.

离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道

目的总结离体肝切除联合自体肝移植治疗晚期肝泡型包虫病(HAE)的方法、安全性和疗效。方法回顾性分析四川大学华西医院于2014年2月到2016年12月期间收治的21例晚期复杂HAE患者的临床资料及随访数据。结果所有患者成功行全离体肝切除联合自体肝移植术,术中无死亡。移植肝质量360~1 300 g,平均701.4 g;手术时间9.4~19.5 h,平均13.6 h;无肝期180~455 min,中位无肝期为314 min;术中失血1 200~6 000 m L,平均2 379 m L;输入红细胞悬液0~39.5 u,平均10.6 u;输入新鲜冰冻血浆0~6 050 m L,平均1 377 m L,其中有7例行自体血液浓缩后回输,输入自体血500~3 700 m L,平均1 578 m L;术后住院时间4~51 d,平均23.5 d。术后发生并发症12例,Clavien-Dindo分级在Ⅲ级及以上者4例;术后死亡2例。术后19例患者获访,1例于术后12个月后失访,随访时间3~38个月,平均随访16.2个月。1例患者于术后3个月出现大量腹水、低钠血症,诊断为左肝静脉吻合口狭窄,介入下行肝静脉支架置入及血管成形术后痊愈。随访期间19例患者未见HAE复发及远处转移。结论离体肝切除联合自体肝移植术为晚期HAE患者提供了根治性切除治疗方法,但手术难度大、风险高,围手术期管理非常重要。术前详细评估、术中合理的管道重建及术后精细管理可提高患者的存活率并降低并发症发生率。

变异ALPPS联合下腔静脉重建治疗晚期肝泡型包虫病

目的探讨变异的肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)联合下腔静脉(IVC)重建在晚期肝泡型包虫病(HAE)中的临床应用效果。方法回顾性分析四川省人民医院于2017年11月收治的1例行变异ALPPS联合IVC重建的晚期HAE患者的临床资料。结果患者术前CT检查提示肝内多发包虫病灶,侵及多个肝段并侵犯肝后下腔静脉及3支肝静脉,仅S6段保留完整的入肝及出肝管道系统,功能残肝体积占标准肝体积的24.9%。完善术前检查后行手术探查,一期结扎门静脉左支及右肝前叶支,增加S6段的门静脉供血,并部分劈裂肝脏。术后恢复顺利,无胆汁漏、感染等并发症发生。一期手术后6个月行二期手术,术前测得功能残肝体积/标准肝体积比值为48.3%。术中完整切除S1–5和S7–8肝段,并用人工血管重建肝后下腔静脉。患者于术后10 d出院,随访18个月期间生存状况良好,无复发及其他并发症发生。结论变异ALPPS联合IVC重建治疗终末期HAE是可行并且安全的。该术式是治疗终末期多发、巨大且残肝体积不足的HAE的有效尝试。